Exercise in Bipolar Disorder: A Testimonial

Here are two letters that basically say “exercise helps” even when depression is pretty bad and you might think it was so bad these women couldn’t exercise at all. Both say it’s the most helpful thing then.

Letter 1

Dear Dr. Phelps –

I have been in remission from bipolar I for the past 10 yrs. I still take depakote SR, work ft. teaching, am 56 yrs. old, had several psychotic episodes with hallucinations etc., but I have been mostly symptom free for 10 yrs. The illness started about ’65; I was on and off lithium since ’78-’91; remained on it after my last and most lengthy episode; after a short stint on SSI, I again returned to ft. teaching. Why don’t we hear about more bp in remission or recovery? Are there any documented studies re: remission? My pdoc says people are in remission from bp; I know some, but I don’t hear about it often, except I have seen several in the hospital who resumed their meds and returned to their jobs, as I did. Since this is a mental illness one can have remission, why is this not documented or addressed more openly; I would like to read more about remission. I contribute a lot of my wellness to remaining of lithium or depakote and aerobic exercise for many years. Also, I don’t think enough is said about exercise as a way of reducing stress and enhancing one’s well being; pharmacies are getting rich, if you know what I mean. My mother was bp, too. I have battled this illness ALL my life and am thrilled to be in remission, but I worked very hard at reducing stress etc. I cannot take anti-depressants, running and bicycling served me very well. I see mostly bp being treated with meds only; I don’t understand how so many hypomanic people cannot exercise; it seems natural and a logical to do. Thank you for listening.

Dear . . . . . — (my reply)

May I use your letter to teach other folks with bipolar disorder? I strongly agree that exercise may have excellent “mood stabilizing” properties just like Depakote and lithium. Unfortunately (relating to your point about the money issue), there is no pharmaceutical company to fund the research to show this effect of exercise, so it is unlikely to have a “randomized controlled trial” as is now the standard in medical evidence for a treatment to be shown to be effective.

Thus, we will have to rely upon people like you to write “testimonials” to the benefits of a treatment. Note that unlike many herbal remedies, or other basically untested treatments, your approach carries very little risk (unless one overdoes it somehow, or has some unrecognized underlying heart problem, for example; thus the usual “check with your doctor first” warning about exercise).

In fact, as surely you are aware, it even has multiple other health benefits. If the effects of exercise could be put in a pill, everyone would want to take it! And finally, exercise basically comes at no cost at all. As the Harvard bipolar expert says, “here’s what you do: go to your doorway, look at your watch, walk seven and a half minutes in any direction you choose, then walk home. Do that every day and you’ll have an excellent basic program”. Therefore, unlike many other “remedies”, exercise can be tried at low risk and very low cost, and even if it doesn’t work as a mood stabilizer, it’s very likely to have other major health benefits.

So why doesn’t everybody adopt such a program? That’s a good question. The answer turns out to be pretty complicated (it’s been studied fairly extensively). I’ve thought about requiring everybody whom I treat to “take the exercise pill” before I give them
anything else — wouldn’t that be something, to have to do something so sensible? But among many limiting factors, as you might have had to work through yourself once, there is this huge one: while it is very hard for a person who’s feeling pretty well to start an exercise program — just look at how few people routinely do it — , it’s much harder for a person who’s overwhelmed by symptoms to do so (especially depression, and perhaps even most especially bipolar depression, which often completely saps a person’s ability to feel motivated to do anything, let alone exercise).

So I’d love to use your letter to “advertise” the benefits of exercise from the point of view of someone who’s really seen the effects, and found them to be as good — clearly better in the long run — as medications. I’d remove anything that identifies you directly if you would allow me to reprint it here and on my website as well. Thanks for writing.

Dr. Phelps

(reply from same person)

Dear Dr. Phelps,

Thank you for your enthusiastic response to my “testimonial” regarding the benefits of exercise. I am honored and pleased that you would want to use my information to hopefully inspire and encourage others suffering from bipolar illness.

Just to add a note: i.e. “one of my benefits of exercise”: After each manic episode, of course I suffered major depression, but in the hospital I could not take anti-depressants, due to mania/psychosis. When I was not in my groups, I was allowed out on passes (when I was not psychotic) to walk. I wanted to get outside of the mental hospital desparately, so I was forced to walk everyday. I was so deeply depressed in the beginning, but as I walked for several weeks everyday, I improved and the depression eventually lifted and disappeared without anti-depressants. I agree it is very difficult to walk etc. when one is suffering depression, but I have forced myself out the door many times, knowing from experience I will feel better when I return home.

I don’t know why I have been in remission for the past 10 yrs., but these have been the best years of my life. I have remained on lithium for the past 10 yrs.; whereas prior to ’91, I stopped lithium several times due to nausea. The past year I started depakote SR, ’cause the lithium became too harsh; also I was dx with H.pylori stomach bacteria about a year ago.

It usually took me 6-8 weeks to adjust to lithium or depakote. Sometimes I wonder if people don’t take enough time to “try” to adjust to meds; especially since now there are so many med choices.

I understand you will not use my name; I have had a few bipolar people become angry” via cyberspace regarding my “testimonial”; but most have not and some people have begun “walking groups”………

Sincerely,

Letter 2 (Short; note the last sentence)

I have noticed some improvement on Tegretol. The medication has worked brilliantly for sleep.I am calmer and don’t get as angry.I still experience severed depressions though. I’m also on Wellbutrin. I am aware antidepressents can cause destabilization in bp, but I have been on Wellbutrin for a year now as it is the only ad i can tolerate. I believe Wellbutrin helps with ADHD symptoms. I am currently working with the mental health clinic and have very limited communication with the doctors so it is very important for me to be well informed about my treatment. … I also have mild paranoia. I am currently on 600 mg of Tegretol and 300 of Wellbutrin. I still run everyday even though i don’t have as much energy. The running has helped me more than anything I’ve tried.